Transitions: How to (Safely) Change Your Billing System

December 15, 2007
Pamela Moore, PhD

If your billing software is a dinosaur, it’s likely costing you big. Switching to a current model takes time and effort, but can you afford not to?


The only thing worse than putting up with bad billing software is the prospect of changing billing software.

It feels so risky. What if something goes wrong and you lose all your data? That’ll make collections a little rough. Suppose everyone learns a new system - and it isn’t any better than your old one? It just seems safer to stay with the tried-if-not-exactly-true solution you already have.

Like many others, such fears are unfounded. Changing your system does take preparation and time, but it can be much less painful than you may imagine. In the long run, you’re likely to become increasingly inefficient and frustrated by sticking with outdated billing software. Determine your needs, prepare for the transition, and throw out your old standby for the hot new thing. Here’s how.

Know what you have

If you’re in the market for a new billing system, chances are your current one isn’t meeting your needs. Determine why before you decide to begin shopping for new software. “The No. 1 reason people update is that their current software is outdated,” says Sarah Drake, a partner at Rochester, Mich.-based EZClaim Medical Billing Software. “If their current vendor hasn’t kept up ... it can become obsolete.”

HIPAA compliance and EMR implementations have driven lots of practices to replace or upgrade their billing software in recent years. Older systems can’t always accommodate the expanded automation and integration new technologies and regulations now require. If this is the case for you, it may be cheaper to start over with a new program than to upgrade your existing one, Drake says.

But just because it’s new doesn’t mean it’s better. Make sure any new system in which you invest will be able to solve your specific problems. Ben Tobin, an engagement manager for Beacon Partners in Boston, has seen countless billing transitions. When a client comes to him ready to switch software he says the first thing he does is ask why: “The first thing to do when you look at any billing system ... is to come back to what’s going wrong now. ... Look at how or if a new system will help you.”

For example, if you’re losing cash because you aren’t obtaining accurate patient data up front, new software probably won’t help unless you improve your verification processes.

But if you are constantly receiving denials because your current system can’t scrub for obscure, local medical necessity rules before sending claims, a new system with robust claim-scrubbing technology could work wonders for your bottom line.

Marianne Dess-Santoro, chief operating officer for the Yale Medical Group, advises physicians to review their work processes and personnel before abandoning existing systems. She says being able to solve recurring billing problems sometimes means learning how to get the most from what you already have; blaming “flawed software” in this case will do no good. “You need to have the right people with the right background to get the information out and manipulate it,” she says. Her group is still happy with a system it bought in 1998. She says it’s reliable, and it produces the data her staff requires to efficiently run her office.

“If you are not fixing the problems, you are just spending money and going through an implementation you don’t need or want,” Tobin warns. “When you are talking to a salesperson, say, ‘I want to do this, this, and this. Show me how your system does it.’”

Look for outcomes you can measure. Software vendors should be able to prove that their packages will provide a cleaner flow of information, help staff process claims faster, and reduce denials or days in A/R, says Kal Patel of Meditab SoftWare in Oakland, Calif.

And don’t overlook your hardware requirements, adds Bob Bridgeman, marketing director with American Medical Software in Edwardsville, Ill. “You need to determine what existing hardware and networking can be used and what needs to be replaced. In some instances, the previous software vendor may actually own some of the hardware,” Bridgeman says. Ask your software vendor about the computers, printers, scanners, and networking equipment necessary to run its programs.

Making the switch

Once you have confidently identified a billing system that you believe to be a good match for your office, prepare for the transition. It’s typically cost-prohibitive to electronically transfer your billing data from an old system to a new one. You may be able to transfer some demographic information such as patient names and addresses, but due to interoperability problems, account details are tough to move.

That’s what Jan Recek, manager of Fremont Medical Associates in Fremont, Neb., discovered. When her practice decided to implement an EMR, her old billing system had to go. But her staff had to work hard to get a new one up and running.


“It would have cost us $5,000 to have the old system integrate with the new system,” Recek explains. “We didn’t want to pay for that. So what we did was print all the patients’ records out and their balances and put them in manually.”

The surgical practice had about 800 records to transfer. Over the course of a few weeks, staff members typed in all recorded activity on each account, with part-timers taking on more hours. Everyone pitched in. “It didn’t take as long as we had thought,” Recek says.

Most billing software changes require at least some type of manual work. “Things are so crazy usually, people want to just push a button and make it work,” Bridgeman says, but you need to expect to put in some work ahead of time.

While your staff hand-enters data into your new system, you may wish to maintain your old system for a while, running the two simultaneously. To prevent confusion, enter all new charges into the new system, but keep your old system up for two to six months after the transition for collections and posting old accounts receivable.

But before attempting this, determine whether you can run both software systems on one computer or server. They may compete with one another and make your operating system go bonkers. Bridgeman advises running them on separate hardware for the short term.

Make sure you have in place a plan for each step of the transition - data entry, training, and closing down your old program.

“Select a realistic ‘go-live’ date to implement the new system,” says Bridgeman. If there is no plan, everyone will get frustrated. Setting a deadline keeps everyone focused on solving problems quickly.

“System conversion should generally take about 45 days,” adds Basil Hourani, president of Pulse Systems. “This includes converting data from the previous product (conversion programs have been written for most competing systems and versions) with multiple rounds of data scrubbing to clean up old databases and years of neglect and misuse. This involves client review and comments on each round until a clean set of data is achieved.”

Be patient

No matter how well you plan, your new system may seem awkward at first. “Despite what you loved or hated about the old system, it’s a natural tendency when you get a new system to compare it to the old one,” Bridgeman says. Hold off comparing and complaining until you have given your new system sufficient time to work for you.

Most billers have experienced several software shifts over their careers, so another one won’t rattle them too much. But they will be disheartened if they perceive that their efforts aren’t paying off. Managers can help by explaining exactly what problems will be fixed and how - and urging patience.

“Preparing the staff is essential to a smooth and successful conversion,” says Hourani. “Building staff buy-in to the concept is achieved by involving them in the decision-making process and the co-developed implementation plan. ... Sharing with the staff previous success stories gets them excited about the new solution and actually gets them to support the change.”

Recek herself realized how good her new system was only after giving it a little time. “Everything is simpler, but for a while there I tried to make it more difficult than it was,” she says, by trying to force the software to require more steps than it did. “I thought, ‘It has to require more than that!’” Today Recek is quite happy doing less.

Changing billing software may intimidate some practices, but shifting to a system more appropriate for your office’s needs can pay off in spades. Drake compares the process to moving from one house to another. “It’s a nightmare, and something has to happen to make you change ... but once it’s done, it’s well worth it.”

Pamela L. Moore, PhD, is senior editor, practice management, of Physicians Practice. She can be reached at pmoore@physicianspractice.com.